In the HME sector, we spend a lot of time explaining what we are against. We are against the competitive bidding program and the way it was implemented. We are against the 36-month cap on oxygen. We are against more cuts to HME. We are against basing Medicare reimbursement on what you would pay for medical equipment purchased on the Internet.

Many terrible slings and arrows have been aimed at HME, and these have required aggressive responses that discuss the negative consequences of bad policy. However, it's hard to go to Capitol Hill, and to the media, with a message that sounds negative. Therefore, we must also talk about what we are for. Our message should reflect the positive, senior-friendly, cost-effective character of home care.

• We are for keeping seniors and Americans with disabilities safe at home, where they can receive the equipment and services they require.
• We are for saving taxpayers money by providing health care in the most cost-effective setting—the home.

Other positive messages will help. Recently, member committees and American Association for Homecare (AAHomecare) councils have been working toward a proactive agenda for 2009. The proposals can be expressed in positive terms.

We are for fair reimbursement that preserves access to care. AAHome­care's Competitive Bidding Task Force is proposing an alternative to competitive bidding. If a viable alternative is not presented, the HME sector will face rebidding of Round One. While the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA)?included reforms to bidding, the larger concern is that this program will be implemented in a way that reduces access to care, and decimates the home care infrastructure.

We are for patient-focused oxygen therapy policy in Medicare. Revised oxygen policy should recognize the services required in providing home oxygen to Medicare beneficiaries. The HME sector is working on an alternative since oxygen therapy is a perennial target for budget cutters. The alternative policy will aim to improve quality of care for patients with lung disease, while providing a payment methodology that meets the needs of beneficiaries and home care providers.

We are for a fraud-free Medicare system. Tax dollars should pay for quality health care, not lining the pockets of criminals. AAHomecare has created an antifraud task force that is proposing tougher measures to keep criminals out of Medicare. Recom­mend­ed actions may include: mandate site inspections for new HME providers and for supplier number renewals; issue provisional supplier numbers for an HME for its first 6 months of operation; require postpayment audit reviews for new providers; initiate real-time claims analysis and a refocus on audit resources; and match ICD-9 Codes with HME claims.

We must still fight bad ideas. At the same time, our audience needs to know how we propose to fix problems. That's our opportunity to explain what we stand for.

Michael Reinemer is vice president for communications and policy at AAHomecare, Arlington, Va. Reinemer can be reached via e-mail: .